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cardiology > clinical approach to a patient with heart disease > Flashcards

clinical approach to a patient with heart disease Flashcards

1
Q

what are symptoms that occur with heart disease

A
  • chest pain
  • palpitations
  • syncope
  • dyspnoea
  • fatigue
  • peripheral oedema
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2
Q

what cardiac diseases does central chest pain point towards

A
  • ischaemic heart disease
  • coronary artery spasm
  • pericarditis/ myocarditis
  • mitral valve prolapse
  • aortic aneurysm/dissection
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3
Q

what non cardiac diseases does central chest pain point towards

A
  • pulmonary embolism

- oesophageal disease

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4
Q

what pulmonary disease does lateral/peripheral chest pain point towards

A
  • infarction
  • pneumonia
  • pneumothorax
  • lung cancer
  • mesothelia
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5
Q

what chest pain does angina present with

A

retrosternal heavy or gripping sensation with radiation to the left arm or neck that is provoked on exertion and lessened with nitrates

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6
Q

what type of pain is aortic dissection

A

severe, tearing chest pain radiating to the back

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7
Q

what type of chest pain is pericarditis

A

sharp, central chest pain that is worse with movement or respiration but relived with sitting forward

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8
Q

what’s orthopnea

A

breathlessness on lying flat

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9
Q

what’s paroxysmal nocturnal dyspnoea

A

when a patient wakes up fighting for breath

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10
Q

what are palpitations

A

Heart palpitations are the sensation that your heart has skipped a beat or added an extra beat. It may also feel like your heart is racing, pounding, or fluttering. You may become overly aware of your heartbeat.

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11
Q

what are premature beats (ectopic beats)

A
  • Felt as a pause and then a forceful beat.

- The second beat is more forceful as the heart has had a longer diastolic period and hence is filled with more blood

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12
Q

what are paroxysmal tachycardias

A

sudden racing heartbeats

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13
Q

what is bradycardia

A

slow, regular heavy or forceful beats

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14
Q

what is syncope

A

the transient loss of consciousness due to inadequate central blood flow

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15
Q

what is a vasovagal attack

A

a simple faint

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16
Q

what is postural (orthostatic) hypotension

A

a drop in systolic BP by 20mmHg or more on standing from a sitting position

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17
Q

what is postprandial hypotension

A

a drop in systolic pressure of 20mmHg or more, or the systolic pressure drops from over 100mmHg to below 90mmHg within 2 hours of eating

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18
Q

what is micturition syncope

A

loss of consciousness while passing urine

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19
Q

what is carotid sinus syncope

A

occurs when there is an exaggerated vagal response to carotid sinus stimulation, provoked by wearing a tight collar, looking upwards or turning head

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20
Q

what is strokes-Adams attack

A
  • sudden loss in consciousness caused by intermittent high grade AV block, profound bradycardia or ventricular standstill.
  • the patient falls to the ground with no warning and is pale and deeply unconscious
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21
Q

why does peripheral oedema occur in heart failure

A

heart failure results in salt and water retention due to renal under perfusion and consequent activation of the RAAS system –> pitting oedema

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22
Q

cardio - general exam

A
  • clubbing - seen in congenital cyanotic heart disease and subacute infective endocarditis
  • splinter haemorrhages - frequently due to trauma and seen in infective endocarditis
  • cyanosis - occurs when the oxygen saturation is less than 85%
    ~ central cyanosis = right to left heart shunt
    ~ peripheral cyanosis = congestive heart failure, circulatory shock, abnormalities in the peripheral circulation
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23
Q

what should the normal pulse rate be

A

60-80 bpm when lying down

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24
Q

what are premature beats

A

occur as occasional or repeated irregularities superimposed on a regular pulse rhythm.

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25
what is atrial fibrillation
- produces and irregularly irregular pulse | - the irregular pattern persists when the pulse quickens in response to exercise
26
what is a collapsing or water hammer pulse
large volume pulse characterised by a short duration with a brisk rise and fall
27
what is a small-volume pulse
seen in cardiac failure, shock and obstructive valvular disease
28
what is a plateau pulse
a small in volume and slow in rising to a peak: due to aortic stenosis
29
what is an alternating pulse (pulses alternans)
regular alternative beats that are weak and strong - feature of severe myocardial failure and is due to a prolonged recovery time of damaged myocardium
30
what is a bigeminal pulse (pulses bigeminus)
caused by a premature ectopic beat following every sinus beat - the rhythm is not regular as every weak pulse is premature
31
what is a dicrotic pulse
results from an accentuated dicrotic wave - occurs in sepsis and hypovalemic shock
32
what information does measuring the JVP give you
observation of the column of blood in the internal jugular system is a good measure of right atrial pressure as there are no valves between the internal jugular vein and the right atrium
33
what does an elevated JVP symbolise
- heart failure - constrictive pericarditis - renal disease with salt and water retention - congestive cardiac failure
34
what are the 3 waves and 2 troughs of the JVP pressure wave
- the peaks are a, c, v | - the troughs are x and y
35
where is the cardiac apex located
5th intercostal space of the midclavicular line
36
what causes the apex to move downwards and laterally
left ventricular dilatation
37
what is a tapping apex
a palpable first sound and occurs in mitral stenosis
38
what is a vigorous apex
may be present in diseases with a volume overload
39
what is a heaving apex
may occur with left ventricular hypertrophy - aortic stenosis, systemic hypertension and hypertrophy cardiomyopathy
40
what is a double pulsation of the apex beat
may occur in hypertrophic cardiomyopathy
41
what is a sustained left parasternal heave
occurs with right ventricular hypertrophy or left atrial enlargement
42
what is a palpable thrill
may be felt overlying an abnormal cardiac valve
43
what is the first heart sound (S1)
due to mitral and tricuspid valve closure - loud = skinny people, hyper dynamic circulation, tachycardias - soft = obesity, emphysema, pericardial effusion, mitral or tricuspid regurgitation
44
what is the second heart sound (S2)
Due to aortic and pulmonary valve closure
45
what causes a third heart sound
"volume overload" - rapid ventricular filling and is present in heart failure
46
what causes a fourth heart sound
pressure overload = occurs in late diastole and is associated with atrial contraction - caused by aortic stenosis, severe systemic hypertension and left ventricular outflow obstruction
47
what causes heart murmurs
due to turbulent blood flow and occur in hyperdynamic states or abnormal valves
48
where are the heart auscultation areas on the precordium
- aortic area = second intercostal space at the right sternal edge - pulmonary area = second intercostal area at the left sternal edge - mitral area = fifth IC at the midclavicular line - tricuspid area = third to fifth ICS at the left sternal edge
49
what is the normal cardiothoracic ratio
less than 50% - a transverse cardiac diameter more than 15.5 is abnormal
50
what are some types of heart enlargement seen on a chest x ray
- left atrial dilatation - left ventricular enlargement - right atrial enlargement - right ventricular enlargement - ascending aortic dilation or enlargement - dissection of the ascending aorta - enlargement of the pulmonary artery
51
why does calcification of the CV system occur
Due to tissue degeneration
52
what is first degree AV block
- consistent prolongation of the PR interval (defined as >0.20 seconds) due to delayed conduction via the atrioventricular node. - every P wave followed by a QRS wave
53
what are ECG findings on first degree AV block
- regular rhythm | - p waves always present followed by a QRS
54
what are clinical features of first degree AV block
usually asymptomatic
55
what is second degree AV block type 1
- also known as Morbitz type 1 AV block - progressive prolongation of PR interval until the atrial impulse is not conducted and the QRS complex is dropped - AV nodal conduction resumes with the next beat and the sequence of progressive PR interval prolongation and the eventual dropping of a QRS complex repeats itself
56
what is the aetiology of second degree AV block type 1
- Increased vagal tone – often seen in athletes (non-pathological) - Drugs – beta-blockers, calcium channel blockers, digoxin, amiodarone - Inferior myocardial infarction - Myocarditis - Cardiac surgery (mitral valve repair, Tetralogy of Fallot repair)
57
what are ECG findings of second degree AV block type 1
- irregular rhythm - every p wave is present bit not all are followed by a QRS complex - PR interval progressivly lenthens before a QRS complex is dropped
58
what are clinical features of second degree AV block type 1
usually asymptomatic but can develop some bradycardia and present with symptoms such as presyncope and syncope
59
what is the management of second degree AV block with type 1
- AV blocking drugs should be stopped - Second-degree AV block (type 1) is usually benign and rarely causing haemodynamic compromise2 - Usually, no intervention is required if the patient is asymptomatic - If the patient is symptomatic a pacemaker may be considered
60
what is second degree AV block type 2
- also known as morbitz type 2 AV block - consistent PR interval duration with intermittently dropped QRS complexes due to a failure of conduction. - The intermittent dropping of the QRS complexes typically follows a repeating cycle of every 3rd (3:1 block) or 4th (4:1 block) P wave.
61
what is aetiology of second degree AV block type 2
- always pathological with the block at the bundle of his or the bundle branches - MI - Idiopathic fibrosis of the conducting system - Cardiac surgery
62
what are ECG findings of the second degree AV block type 2
- irregular rhythm - p wave present but there are more p waves than QRS complexes - consistent normal PR interval duration with intermittently dropped QRS complexes
63
what are clinical features of second degree AV block type 2
- asymptomatic - palpitations - pre-syncope - syncope - regularly irregular pulse
64
what is third degree (complete) AV block
- when there is no electrical communication between atria and ventricles die to a complete failure of conduction - p waves and QRS complexes that have no association with eachother due to atria and ventricles working independently - narrow complex escape rhythm origionate above the birfurcation of the bundle of His
65
what causes third degree AV block
- congenital - idiopathic fibrosis - ischaemic heart disease - non ischaemic heart disease - Iatrogenic - drug related - infections - autoimmune conditions
66
what are ECG findings of third degree AV block
- variable rhythm - p wave present but not associated with the QRS - PR interval abscent
67
what are clinical features of the third degree AV block
- palipitations - pre syncope - confusion - SOB - chest pain - sudden cardiac death - irregular pulse - profound bradycardia

cardiology (13 decks)

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